The Development of ‘A Germ’s Journey’: Interactive Health Education Resources for Children in the UK and Internationally

This thesis reports on the findings of four studies, as part of a wider project (‘A Germ’s Journey’), which aimed to investigate the effectiveness of a set of specifically developed educational resources designed to teach young children about pathogen transmission and handwashing in the UK and India. Furthermore, the thesis evaluates the study’s co-creation approach to developing the resources for the UK, India and Sierra Leone (such as books, posters, webgames, songs/videos) as well as exploring how wider public health information can be disseminated to communities. The methods used to evaluate the usefulness of the resources for teachers and parents, and children’s engagement and understanding after completing the pedagogic workshops include questionnaires (completed by parents and teachers), observations of the children during the workshops, follow-up interviews with teachers and pre and post workshop questions and worksheets for children. Data was collected across a total of 19 case study sites (n=790) including primary schools and community centres in the UK and rural areas in India (studies 1 and 2). To evaluate the approach of co-creation, qualitative data was drawn from in-depth interviews with five key stakeholders including a learning and engagement officer at the Thinktank Birmingham Science Museum (UK), an Assistant Director for the office of international relations and projects at the University of Makeni (Sierra Leone), a project co-ordinator at Manav Sadhna charity (India) a member of the Marketing team at PAL International, cleaning products manufacturers (UK) and an Early Years Foundation Stage (EYFS) Teacher (UK). Focus group data from 37 teachers in Sierra Leone and responses to open-ended questionnaires completed by 66 teachers in India and 63 in the UK was also gathered (Study 3). Lastly, specialists across seven countries took part in five semi-structured podcast interviews discussing different communication techniques with the aim to challenge and aid our understanding of global health communications, particularly on the use of community-focussed approaches (Study 4). Results found that the learning resources were successful in aiding children in the EYFS’ understanding of germs and hand-hygiene (80–100% of parents and teachers strongly agreeing/agreeing), with teachers reporting that they had seen an increased knowledge in their pupils (UK). In India, two months after participating in the workshops using the original UK resources, 60%–73% of children knew the relationship between germs and illness, and 76%–80% knew how to remove germs from hands. After completing a workshop using newly co-created Gujarati resources, 54% of children scored higher afterwards, showing an increased understanding of microbiology (Studies 1 and 2). As a result of the interviews regarding the co-creation approach, themes regarding teamwork, shared ownership and improved outcomes were explored alongside the importance of working with appropriate partners and understanding the significance of local context, especially in low-and-middle-income countries (LMICs) (Study 3). Three key challenges to public health communications were identified within the podcast discussions: digital literacy, the digital divide and misinformation. Having discussed ways in which to combat these three barriers, the importance of audience research to overcome issues surrounding digital literacy; multimodal dissemination in response to the digital divide and using trusted sources to reduce the spread of misinformation was highlighted (Study 4). Following the use of A Germ’s Journey co-created resources, children had an improved understanding of the causes of bacterial disease and the health implications of not using adequate health-hygiene practices in both the UK and India. Recommendations for the future development of resources include the use of a Participatory Research Model of research, co-creation with end users, and working alongside local organisations and participants to access ‘hard-to-reach’ areas, however it is important to consider the challenges of logistics and in managing the potentially conflicting goals within the Co-Creation process. When disseminating health information, traditional methods, often utilised by larger media outlets, are not always effective. Empowerment and collaboration/co-creation to tailor information to different communities and using community-focussed models of communication are key. Researching and working alongside end-users and utilising multimodal dissemination enables valuable and successful health communications.